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A Children’s Hospital in Texas: TLC for the RN

The Registered Nurse (RN) is a hot commodity in the healthcare industry. Unlike many professions that are experiencing decreased job opportunities, the RN is in high demand—especially within the hospital setting. So why are RNs leaving the workforce?

In a nutshell, it is the existence of an unhealthy work environment. There are too many sick patients to be cared for by too few RNs who are experiencing too much stress, which is often compounded by conflict with doctors and RN co-workers.

This increased job demand for RNs working in hospitals is now a well-known fact. Newspapers and TV reporting frequently describe personal horror stories that exemplify the RN shortage. Too few RNs result in more and more RNs leaving the patient’s bedside because the patient care load is too high. And in an effort to address the issue, the federal government has released millions of dollars for career development retention efforts to improve the numbers of RNs in the workforce.

While lack of adequate RN staffing is critical in all acute care settings, a children’s hospital is certainly the worst place one can imagine for the RN shortage to exist. And in one particular children’s hospital in Texas, there was a real crisis. An unprecedented drop in the number of available RNs, coupled with the increasing number of very sick children, created a workplace situation of ever-increasing stress for the hospital staff RNs and extreme job dissatisfaction. And future RN shortages were looming: a pediatric surgical unit, for example, was desperate for help because 48% of their RNs were leaving within a year.

The hospital’s RN leadership had to do something that was immediate. A federal grant was written and the hospital was awarded $1.2 million dollars to improve nurse retention through its Nurse Retention, Patient Care Improvement Project. After attending a public workshop of The Leadership Challenge, the project director spearheaded the development of a two-day workshop using this evidence-based leadership development tool for the hospital’s front-line managers. The surgical unit director who was facing the 48% turnover, in particular, made a conscious effort to incorporate the principles of The Leadership Challenge into her and her managers’ leadership styles. She and her manager team made public their inspirational shared vision, embedded their leadership behavior development into the agenda of all meetings, and continually promoted their vision and leadership development—despite many obstacles.

After 18 months of applying the guiding practices of The Leadership Challenge, this children’s hospital surgical director is presenting great outcomes at a national conference this year. Her unit’s an annual turnover rate for RNs has gone from 48% to 17%. And job satisfaction surveys show statistically significance improvement: an increase of 14% of RNs who would recommend their organization as a good place to work and an increase of 10% who say they want to stay at least three more years. Job satisfaction survey scores now place them as the top surgical unit for all children’s hospitals in the nation.

Sally Carmen, RN, MSN, CPNP is Director of Education & Organizational Development at North Hills Hospital in North Richland Hills, Texas. She can be reached at sally.carmen@hcahealthcare.com.